“火”与“热”理论探析

Theoretical exploration of“fire”and“heat”

《黄帝内经》记载“在天为热,在地为火”,表明“火”与“热”是有区别的,由于“火”与“热”在某些方面具有一致性,“火”具有“热”的温煦特性,又“火”的致病特点大多为实热证,所以现代部分医家在论“火”和“热”时往往“火热”并称,使两者之间的界限变得更加模糊。“火”和“热”本质是不同的,“火”是物质属性和阴阳五行属性,具有“炎上”的特性,“热”是一种自我感知不是物质。“火”是有形的火焰,是局限的,“热”是无形而弥散的。两者在病因病机方面大致相同,有“火为热之极,热为火之渐”之说,“火”与“热”的致病特点都是阳盛,清热法是治疗火热病的“正治”。在这些方面两者具有一致性。但是有的“热”不是“火”,如外感寒邪导致的壮热是热但不是火,只有在壮热的基础上同时有舌绛、口干、苔糙、神昏谵语等症状表现才为火。也有的“火”不是“热”,如李杲(号东垣)所说的“阴火”是在气虚基础上产生的郁火,阴火的另外一种形式是阴盛于内,格阳于外,火不归原而产生的火;龙雷之火是由肾阴亏虚,阴不敛阳而产生的,这些是“火”但不是“热”。所以正确解读“火”和“热”,分清其本质的不同,才能对疾病有清楚的认识,在治疗过程中才能准确掌握病因病机,正确施治。

Huangdi Neijing(《黄帝内经》)records that“Heat is in the sky,fire is in the ground”,indicating that there is difference between“fire”and“heat”.Because“fire”and“heat”have consistency in some aspects,“fire”has the warm characteristics of“heat”,and the pathogenic characteristics of“fire”are mostly excessive heat syndrome,some modern doctors often combine“fire”and“heat”,making more blurred boundary between the two.“Fire”and“heat”are different in essence,“fire”is the property of material and one of Yinyang(阴阳)and five elements,with the characteristics of‘inflammation”,while“heat”is a self-perception,which is not material.“Fire”is tangible flame and it is limited,“heat”is invisible and diffuse.In terms of etiology and pathogenesis,the two are roughly the same,there is a saying that“fire is the pole of heat,heat is the gradual development of fire”.The pathogenic characteristics of“fire”and“heat”are Yang(阳)flourishing.The method of clearing heat is the“correct treatment”of fire heat diseases.In these respects,the two are consistent.But some“heat”is not“fire”,such as external cold evil caused by strong heat is hot but not fire,and it is“fire”only on the basis of strong heat,at the same time,it shows the crimson tongue,dry mouth,rough moss,delirium and other symptoms of the fire.Some“fire”is not“heat”,such as what is called“Yin(阴)fire”by LI Gao,it is produced on the basis of Qi(气)deficiency of stagnant fire,another form of Yin fire is“There are abundant interior Yin fire,which prevents exterior Yang and the fire does not return to its origin”.The fire of dragon thunder is caused by the deficiency of kidney Yin and the failure of Yin to collect Yang.These are“fire”but not“heat”.Therefore,to interprete“fire”and“heat”correctly and to distinguish their essential difference will help to have a clear understanding of the disease,and in the course of treatment,only an accurate grasp of the etiology and pathogenesis can lead to correct treatment.